CV-Blood Week 2 Flashcards
A group of 60 year-old men volunteered for evaluation in a cardiovascular study. All appeared healthy with no history of cardiovascular disease. The loop-labeled “Patient A” was recorded from a 60-year-old man who recounts a mild viral infection four weeks ago. The loop labeled “Control” was from another volunteer. When compared to the control loop, the left ventricular pressure-volume loop from patient A demonstrates which of the following changes?
a. Drug related increased contractility
b. Viral myocarditis-related increased end-systolic pressure
c. Increased pulmonary artery wedge pressure due to valvular disease
d. Increased systemic vascular resistance from age-related vessel stiffening
e. Valve disease-related ventricular dilation
A group of 60 year-old men volunteered for evaluation in a cardiovascular study. All appeared healthy with no history of cardiovascular disease. The loop-labeled “Patient A” was recorded from a 60-year-old man who recounts a mild viral infection four weeks ago. The loop labeled “Control” was from another volunteer. When compared to the control loop, the left ventricular pressure-volume loop from patient A demonstrates which of the following changes?
a. Drug related increased contractility
b. Viral myocarditis-related increased end-systolic pressure
c. Increased pulmonary artery wedge pressure due to valvular disease
d. Increased systemic vascular resistance from age-related vessel stiffening
e. Valve disease-related ventricular dilation
Explanations:
E – Pt has incompetent aortic valve resulting in AR and LV dilatation. Regurgitant flow is evident from the isovolumetric phases of the graph (which are not isovolumetric – the volume increases when the valves should be closed). Pulse pressure also increases on the graph due to retrograde flow through an incompetent valve decreased DBP. Volume overload leads to increased compliance as the heart dilates.
A – Contractility decreases, B – end systolic pressure decreases, C – mean pulmonary artery wedge pressure is estimated by the end diastolic pressure – which is identical in both loops, D – DBP (which is largely determined by SVR) is lower in patient A than in the control
A 72-yr-old man with a history of type II diabetes and hypertension is brought to the ED because of sudden onset chest pain and dyspnea. His pulse is 110/min and blood pressure is 90/60 mm Hg. Cardiac auscultation reveals no murmurs, rubs, or gallops. Because of his hemodynamic instability, a central venous catheter is placed. The image shows the central line tracings from a normal patient during one cardiac cycle with corresponding aortic, left ventricular, and left atrial pressures. At which of the following points on the curve is the sarcomere length of the left ventricular muscle fibers the smallest?
A
B
C
D
E
F
A 72-yr-old man with a history of type II diabetes and hypertension is brought to the ED because of sudden onset chest pain and dyspnea. His pulse is 110/min and blood pressure is 90/60 mm Hg. Cardiac auscultation reveals no murmurs, rubs, or gallops. Because of his hemodynamic instability, a central venous catheter is placed. The image shows the central line tracings from a normal patient during one cardiac cycle with corresponding aortic, left ventricular, and left atrial pressures. At which of the following points on the curve is the sarcomere length of the left ventricular muscle fibers the smallest?
A
B
C
D
E
F
Explanation: Sarcomere length is smallest when the left ventricle is at maximal contraction
A 65-yr-old woman presents to the ER with shortness of breath. She has a history of diabetes and myocardial infarction 2 years ago. Cardiac exam reveals a displaced point of maximal impulse. Pulmonary auscultation reveals bilateral crackles and decreased breath sounds. Examination of her neck reveals normal JVP. Which of the following physical exam findings is most likely associated with this patient’s condition?
a. S3
b. Ascites
c. Pedal edema
d. Spleen and liver enlargement
A 65-yr-old woman presents to the ER with shortness of breath. She has a history of diabetes and myocardial infarction 2 years ago. Cardiac exam reveals a displaced point of maximal impulse. Pulmonary auscultation reveals bilateral crackles and decreased breath sounds. Examination of her neck reveals normal JVP. Which of the following physical exam findings is most likely associated with this patient’s condition?
a. S3
b. Ascites
c. Pedal edema
d. Spleen and liver enlargement
Explanation: Left heart failure. C, and D are all right heart failure.
A middle-aged woman reports episodes of fainting and dizziness while standing at her job. Her seated blood pressure is 123/72 mm Hg and pulse is regular at 75/min. Hemodynamic studies are performed to evaluate her. Her blood volume is 4.2 L and resting cardiac output is 4.2 L/min. In the supine posture at rest, which of the following vascular structures will most likely contain the largest proportion of the total blood volume in this patient?
a. Aorta and larger arteries
b. Arterioles
c. Capillaries
d. Chambers of the heart
e. Pulmonary vasculature
f. Vena Cavae
g. Venules and veins
A middle-aged woman reports episodes of fainting and dizziness while standing at her job. Her seated blood pressure is 123/72 mm Hg and pulse is regular at 75/min. Hemodynamic studies are performed to evaluate her. Her blood volume is 4.2 L and resting cardiac output is 4.2 L/min. In the supine posture at rest, which of the following vascular structures will most likely contain the largest proportion of the total blood volume in this patient?
a. Aorta and larger arteries
b. Arterioles
c. Capillaries
d. Chambers of the heart
e. Pulmonary vasculature
f. Vena Cavae
g. Venules and veins
Explanation: Just a fact that venous system has the most capacitance and is the reservoir for blood
A healthy 25-yr-old woman begins a program that includes weight lifting and high-intensity static exercise. Which of the following is most likely to occur within her skeletal muscles during contraction while performing this type of exercise?
a. Decreased blood flow and increased vascular resistance
b. Decreased extracellular potassium concentration
c. Increased arteriolar diameter and increased flow
d. Increased ADP/ATP ratio
e. Increased intracellular potassium concentration
A healthy 25-yr-old woman begins a program that includes weight lifting and high-intensity static exercise. Which of the following is most likely to occur within her skeletal muscles during contraction while performing this type of exercise?
a. Decreased blood flow and increased vascular resistance
b. Decreased extracellular potassium concentration
c. Increased arteriolar diameter and increased flow
d. Increased ADP/ATP ratio
e. Increased intracellular potassium concentration
Explanation: Muscle contraction compresses and collapses vessels leading to increased resistance and decreased blood flow.
A 51-yr-old woman is admitted to the hospital for an elective cardiac catheterization because of a 9-month history of worsening fatigue and shortness of breath. The results of cardiac catheterization are shown:
Pulmonary artery pressure: 45/25 mmHg
Pulmonary wedge pressure: 30 mmHg
Left ventricular pressure: 120/5 mmHg
Aortic pressure: 120/80 mmHg
What is the most likely diagnosis?
a. Aortic regurgitation
b. Aortic stenosis
c. Mitral regurgitation
d. Mitral stenosis
e. Myocardial infarction
A 51-yr-old woman is admitted to the hospital for an elective cardiac catheterization because of a 9-month history of worsening fatigue and shortness of breath. The results of cardiac catheterization are shown:
Pulmonary artery pressure: 45/25 mmHg
Pulmonary wedge pressure: 30 mmHg
Left ventricular pressure: 120/5 mmHg
Aortic pressure: 120/80 mmHg
What is the most likely diagnosis?
a. Aortic regurgitation
b. Aortic stenosis
c. Mitral regurgitation
d. Mitral stenosis
e. Myocardial infarction
Explanation: Elevated pulmonary capillary wedge pressure and elevated pulmonary artery pressure. Normal LVEDP that is unequal to the pulmonary wedge pressure. A pressure gradient between 5-30 mmHg is indicative of mitral stenosis.
A 25-year old woman comes to the physician for a routine exam. She is healthy and experiences no symptoms however on cardiac examination a mid-systolic click is heard. Which of the following valvular abnormalities is most likely present in this patient?
a. Ballooning of valve leaflets
b. Fibrous bridging between thickened, leaflets
c. Irregular beads of calcification in annulus
d. Large, bulky vegetation with adjacent leaflet perforation
e. Tiny vegetations along the line of closure of valve leaflet
A 25-year old woman comes to the physician for a routine exam. She is healthy and experiences no symptoms however on cardiac examination a mid-systolic click is heard. Which of the following valvular abnormalities is most likely present in this patient?
a. Ballooning of valve leaflets
b. Fibrous bridging between thickened, leaflets
c. Irregular beads of calcification in annulus
d. Large, bulky vegetation with adjacent leaflet perforation
e. Tiny vegetations along the line of closure of valve leaflet
Explanations:
A – mitral valve prolapse, B – Mitral stenosis (rheumatic fever), C – Elderly individuals (normal aging), D – Acute bacterial endocarditis, E – Marantic (nonbacterial thrombotic) endocarditis
A 13-yr-old boy is brought to the physician because of pain and swelling in his knees and ankles along with a recent onset fever. He had an upper respiratory infection two weeks ago, for which he received acetaminophen. His temperature is 100.4F, pulse is 110/min, respirations are 22/min, and blood pressure is 115/76 mmHg. Physical exam shows erythematous skin macules with a clear center, arthritis, and small subcutaneous nodules on the dorsal aspect of the arms. A systolic murmur in the mid-precordial area is heard on auscultation of the chest. Which valvular issue best explains this patient’s symptoms.
a. Mitral stenosis
b. Tricuspid regurgitation
c. Mitral regurgitation
d. Tricuspid stenosis
e. Aortic stenosis
A 13-yr-old boy is brought to the physician because of pain and swelling in his knees and ankles along with a recent onset fever. He had an upper respiratory infection two weeks ago, for which he received acetaminophen. His temperature is 100.4F, pulse is 110/min, respirations are 22/min, and blood pressure is 115/76 mmHg. Physical exam shows erythematous skin macules with a clear center, arthritis, and small subcutaneous nodules on the dorsal aspect of the arms. A systolic murmur in the mid-precordial area is heard on auscultation of the chest. Which valvular issue best explains this patient’s symptoms.
a. Mitral stenosis
b. Tricuspid regurgitation
c. Mitral regurgitation
d. Tricuspid stenosis
e. Aortic stenosis
Explanation: Rheumatic fever, S. pyogenes = mitral regurgitation
A 47-yr-old man from Brazil comes to the physician because of edema and dyspnea. He is otherwise healthy. His temperature is 100F, pulse is 96/min, and BP is 120/75 mmHg. Physical exam reveals bilateral crackles. Echo reveals decreased end diastolic volume and increased compliance. Endocardial biopsy shows fibrosis of the endocardium. The myocardium has focal necrosis and inflammatory infiltrate. Congo-red stain is negative. What is the most likely diagnosis?
a. Alcoholic cardiomyopathy
b. Cardiac amyloidosis
c. Endomyocardial fibrosis with hypereosinophilia
d. Viral endocarditis
A 47-yr-old man from Brazil comes to the physician because of edema and dyspnea. He is otherwise healthy. His temperature is 100F, pulse is 96/min, and BP is 120/75 mmHg. Physical exam reveals bilateral crackles. Echo reveals decreased end diastolic volume and increased compliance. Endocardial biopsy shows fibrosis of the endocardium. The myocardium has focal necrosis and inflammatory infiltrate. Congo-red stain is negative. What is the most likely diagnosis?
a. Alcoholic cardiomyopathy
b. Cardiac amyloidosis
c. Endomyocardial fibrosis with hypereosinophilia
d. Viral endocarditis
Explanation: Chagas disease (T. Cruzi) Parasite so hypereosinophilia.
